
<div style="margin-left: 70px;
width: 325px;">
<?php if(Yii::app()->user->hasFlash('success')):?>
    <div class="flash-success" style="height:30px;color:black;background-color:#ACAC75;">
   
        <?php echo Yii::app()->user->getFlash('success'); ?>
    </div>
<?php endif; ?>
<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'appointment-form',
	'enableAjaxValidation'=>false,
)); ?>

	<p class="note">Fields with <span class="required">*</span> are required.</p>



	<div class="code_generation_field_text">
		<?php echo $form->labelEx($model,'firstname'); ?></div>
    
    <div class="code_generation_field_box">
		<?php echo $form->textField($model,'firstname',array('size'=>60,'maxlength'=>250,'class'=>"code_generation_field")); ?>
		<?php echo $form->error($model,'firstname'); ?>
	</div>

	<div class="code_generation_field_text">
		<?php echo $form->labelEx($model,'lastname'); ?></div>
    <div class="code_generation_field_box">
		<?php echo $form->textField($model,'lastname',array('size'=>60,'maxlength'=>250,'class'=>"code_generation_field")); ?>
		<?php echo $form->error($model,'lastname'); ?>
	</div>

	<div class="code_generation_field_text">
		<?php echo $form->labelEx($model,'email'); ?></div>
    <div class="code_generation_field_box">
		<?php echo $form->textField($model,'email',array('size'=>60,'maxlength'=>250,'class'=>"code_generation_field")); ?>
		<?php echo $form->error($model,'email'); ?>
	</div>
   
	<div class="code_generation_field_text">
		<?php echo $form->labelEx($model,'phone'); ?></div> 
    <div class="code_generation_field_box">
		<?php echo $form->textField($model,'phone',array('class'=>"code_generation_field")); ?>
		<?php echo $form->error($model,'phone'); ?>
	</div>

	<div class="code_generation_field_text">
		<?php echo $form->labelEx($model,'date'); ?></div>
    <div class="code_generation_field_box" style="margin-right: 215px;width: 100px ! important;border-radius: 25px;">
		<?php $this->widget('zii.widgets.jui.CJuiDatePicker', array(
  'model'=>$model,
  'attribute'=>'date',
  'value'=>$model->date,
  // additional javascript options for the date picker plugin
  'options'=>array(
    'class'=>'code_generation_field',
    'showAnim'=>'fold',
    'showButtonPanel'=>true,
    'autoSize'=>true,
    'dateFormat'=>'yy-mm-dd',
    'defaultDate'=>$model->date,
   ),
)); ?>

		<?php echo $form->error($model,'date'); ?>
	</div>
    
	<div class="code_generation_field_text">
		<?php echo $form->labelEx($model,'reason'); ?></div>
    <div class="code_generation_field_box2">
		<?php echo $form->textArea($model,'reason',array('size'=>60,'maxlength'=>500,'class'=>"code_generation_field2")); ?>
		<?php echo $form->error($model,'reason'); ?>
	</div>
  


	<div class="mail_send">
		<?php echo CHtml::submitButton($model->isNewRecord ? 'Create' : 'Save',array('class'=>'mail_send_btn')); ?>
	</div>

<?php $this->endWidget(); ?>

